US: Rural Health Quarterly investigates the impact of HIV criminalisation and stigma in rural America

The little brown church in Nashua, Iowa, has a certain notoriety. In the mid-1800s, a music teacher passing through the town wrote a song about a church that he envisioned there. It was a perfectly prophetic gesture.

A few years later, a church was erected on that very spot—even though its parishioners had never heard the teacher’s song. Ever since, the church has been a special place—and a popular destination for weddings. As of August 2014, over 74,000 had taken place there.

One of those was Tami Haught’s. On November 27th, 1993, just two days after Thanksgiving, she married Roger in a joyful ceremony. But unbeknownst to the guests, the newlyweds harbored a dark secret: Roger had AIDS, and Tami had HIV.

“The doctor said to cancel [the wedding] because [Roger] wouldn’t live,” Haught said.

Roger had been diagnosed with AIDS a few months before, on August 4th. Tami was diagnosed with HIV on August 23rd, the day before her 25th birthday.

Roger lived for almost three years after his diagnosis. He died about two months before the birth of their son Adrian.

In those three years, Roger and Tami chose to love each other. But in the outside world, they suffered a lot—especially from the stigma.

“Back in the 90s, if you had cancer, people cared. If you had AIDS, people judged,” Haught said.

Roger was diagnosed with HIV in 1984, but shortly thereafter, following a car accident, his bloodwork came back with a false negative for HIV. Wanting to believe that he didn’t really have HIV, Roger didn’t question those results, and never mentioned his previous HIV diagnosis to anyone—not even his fiancé.

“I didn’t have time to blame him,” Tami said. “I had slept with him without having the conversation. I had put myself at risk.”

“It was a heterosexual foolery that we didn’t have to worry about it, because we were straight, or didn’t do drugs,” Tami continued. “It was a rude awakening, and proof that HIV doesn’t discriminate.”

Like much of the American public during the late 80s and 90s, Roger’s own family struggled to understand HIV/AIDS and accept that he had it. What made Roger’s situation worse is that he himself never really accepted it, Haught added.

“He was a redneck, homophobic cowboy, and he absolutely hated living with AIDS,” Haught said.

Tami and Roger moved back to Roger’s native rural Texas briefly after their wedding because that’s where he wanted to live, but they didn’t find adequate support there, and Roger didn’t want to go to the doctor and risk being seen.

So they moved back to Iowa where he could be somewhat anonymous. He was treated two hours away from Haught’s hometown, at the University of Iowa Hospitals and Clinics in Iowa City, a university town. They told everyone except their families that he had cancer.

Three or four months before Roger died, he told Haught that he couldn’t keep fighting.

“Finally, it was emotionally as well as physically that he was tired. And passed away.”

The death certificate says he died of kidney failure.

“But what the death certificate doesn’t show are all the mental issues,” Haught said.

THE SEEDS OF STIGMA

Haught will always remember the day she disclosed her HIV status to her family: February 10th, 1993. A couple of months after her wedding.

“It’s a day that my sister will never forget,” Tami said. “I disclosed it in probably one of the absolute worst ways. I came home. I had gotten some flyers and brochures [on HIV/AIDS]. I threw them on the coffee table. [I said] ‘Roger has AIDS. I am living with HIV. I don’t know how long I will live. I’m tired, and I’m going to bed.’

“They sat there in shock,” Tami continued. “My brother stood up and gave me a hug and said: ‘No matter what you need, we love you. We’re here for you.’ Some people are disowned. I was very lucky that I’ve always had their support.”

That was especially true because they were living in a punitive social environment. Several states, including Iowa, had criminalization laws against people for not disclosing their HIV status to partners.

“In order to get Ryan White funding, states had to prove that if somebody was intentionally propagating HIV, they could be prosecuted,” Tami said. The Ryan White Care Act, also known as the AIDS Prevention Act of 1990, was designed to improve the care of people with HIV/AIDS, especially those without insurance.

To receive funding, states had to enact disclosure laws, which thirty-three states did.

“Iowa’s was the most punitive,” Tami said. “In Iowa, if you could not prove you had disclosed your status, you were sentenced to 25 years in jail and put on a sex offenders’ registry.”

But proof of disclosure was difficult, not least because the burden of proof was always on the person with HIV, Haught said. As a result, the law sometimes became a weapon against people with HIV.

“People stayed in abusive relationships,” Haught said. “[Partners would say things like], ‘If you break up with me, I will tell police that you did not disclose your status.’”

The laws were also enacted at a time when there was limited medical knowledge about the disease and how it is transmitted.

“In Texas, someone got thirty years for spitting at a corrections officer,” Haught recalled. “You cannot get HIV from spitting.”

Haught dealt with discrimination head-on in Iowa while she was raising her son. She first ran into it when she went to introduce herself at his preschool.

“The first time I went to meet [the teachers], they didn’t want to shake my hand,” she said.

Haught had a case manager who guided her through those early years of disclosing her HIV status in school environments. For example, she agreed not to make homemade treats at preschool—and to be fair, all the other parents agreed they also wouldn’t make treats.

“Luckily, Adrian didn’t have any issues until eighth grade,” Haught said. “A friend of his came over and made fun of Adrian. He said his mom had AIDS and was going to die.”

Haught called the boy’s father, who made him stop. But still, the seeds of that stigma—along with Haught’s fear of her own death—stayed with her.

“I never imagined that I would live long enough to see [Adrian] graduate in 2015,” Haught said. “I was a blubbering mess. On December 27th of this year, he made me a grandma.”

Haught said that she began living to live—instead of die—about twelve years ago. She was at the dentist, and the hygienist cleaning Haught’s teeth scolded her lightly for not flossing her teeth every day.

“She said, ‘In ten years, when you start losing your teeth, you will regret it,’” Haught said. “I knew the diagnosis was that we were living longer, healthier lives, but I just never believed it having lived through the loss of my husband.”

“But it was the trigger for me to think about what I was going to do if I didn’t die,” Haught said.

What she did was throw herself into activism.

THE EVOLUTION OF A CAUSE

Haught started an advocacy group in 2006 called PITCH, which stands for Positive Iowans Taking Charge. They now have about 125 members, with various support groups throughout the state and an annual wellness summit.

“Some people say they look forward to it every year,” Haught said. “It’s the only time they can be themselves and ultimately admit they have HIV. The rest of the year, they live in silence.”

Haught also became involved with a national group called SERO, which is focused on ending inappropriate criminal persecutions of people with HIV. They are helping to repeal, state by state, criminalization laws that are rooted in a poor understanding of HIV transmission. Most laws do not consider that correct and consistent condom use as well as the use of antiretroviral therapy reduces the risk of transmission to a negligible level.

The National HIV/AIDS Strategy, released by the White House in 2010, also called attention to the problem of HIV criminalization, and the CDC has encouraged states to revisit these laws. The American Psychological Association has spoken out against HIV criminalization, recommending the repeal or reform of these laws so that they only punish HIV positive people who intentionally engage in behavior that is risky for transmission.

On its website, SERO lists several recommended actions for HIV positive people to protect themselves, including having sexual partners sign disclosure forms and saving all written communication should it be questioned.

So far, two states have reformed their laws: Iowa and Colorado. In 2014, Iowa replaced the 25-year flat prison sentence with a tiered sentencing system, depending on the circumstances of HIV transmission.

“I was actually speechless,” said Haught, who between 2012 and 2014 served as community organizer for CHAIN (Community HIV/Hepatitis Advocates of Iowa Network). Five days later, 200 activists came to Iowa to celebrate—and to ceremoniously cut off the ankle monitors on two HIV positive Iowans who had been forced to wear them under the old law.

Last May, Colorado became the second state to reform its laws.

“We’re working in other states to make progress,” Haught said, who as SERO’s organizing and training coordinator travels around to different states lobbying legislators.

“It’s really tough in the South,” she added.

THE LAW THAT ALMOST TOOK DOWN AN OLYMPIAN

In March, Haught was lobbying in Florida, the state with the highest number of HIV diagnoses. It is fourth in the nation for people living with HIV/AIDS.

Darren Chiacchia, an equestrian who won the Bronze medal in the 2004 Olympics, is one of those people. Chiacchia, who lives for part of the year on a horse farm in North Central Florida (and the other part in upstate New York) also knows first-hand the challenges of Florida’s HIV criminalization law and the stigma surrounding it.

In 2009, Chiacchia’s former lover Chandler decided to take revenge on Chiacchia for ending their four-month relationship: Chandler filed a report to the Marion County Sheriff’s Department claiming that he had found out about Chiacchia’s HIV status only one month before. Had that been true, Chiacchia would have violated Florida law by having had sex more than once without revealing his HIV status to his partner.

Chiacchia says he told Chandler about his status on their first date. “His [Chandler’s] reaction was, ‘True love will prevail,’” Chiacchia said.

But the relationship was rocky from the start, and every time Chiacchia tried to end it, Chandler threatened him with: ‘Don’t do this. Your life will be over as you know it.’

The twist in the story is that there were times that Chiacchia questioned his own truth. “He [Chandler] almost had me convinced that I hadn’t told him,” Chiacchia said.

A near-fatal horse accident in 2008 had left Chiacchia with Traumatic Brain Injury, which often comes with deep memory lapses. Incidentally, it was while hospitalized for the accident that Chiacchia found out he had HIV.

“It didn’t really freak me out,” he said. “It was just something that had to be taken care of.”

While recovering from the accident, Chiacchia fell into his relationship with Chandler. He was vulnerable, and his brain, he said, was “very malleable.”

It was only when Chiacchia, who’d made millions as a professional athlete, was sliding into bankruptcy to defend his case, that he began to recover his memory. To make sure his tax returns were up to date, he did his own forensic accounting, collecting the restaurant and country club receipts. That unlocked his memory about the night he told Chandler that he had HIV.

He reconstructed that night, and went back to the restaurant where he’d taken Chandler.

“I sat at the same stool at the end of the bar. I ordered my same favorite cocktail. I ordered my same favorite meal, and then afterwards I pulled into the same vacant parking lot where it all happened,” he said.

At that point, the case might have just ended up being a case of conflicting reports, but Chiacchia had a few other factors in his favor:

“Florida statute reads that the person must be informed,” Chiacchia said. “So what about the three other people who told him [my HIV status] instead?”

They all testified in favor of Chiacchia.

Also, to sue someone for HIV-related crimes, Chiacchia explained, HIV transmission must take place. “He [Chandler] gleefully reported himself negative,” Chiacchia said.

In February, after eight years of legal battles and debt, the Florida assistant state attorney dropped all charges against Chiacchia. It was the start of the biggest horse show of the year in Marion County, known as the horse capital of the world. It is Florida’s fifth largest county, as well as one of its most rural.

Chandler had suffered stigma living there during the eight years of his legal battles. He was in earshot of comments like, ‘They’re a couple of queers. They belong in jail anyway,’ Chiacchia said. His livelihood training equestrians and buying and selling prize horses suffered.

“People were quick to judge. My life as I knew it was over,” Chiacchia said. “That’s the stigma we’re talking about.”

That all changed when his case was cleared.

“The week the news hit was the first day of the horse show, and I think I got twenty-five hugs from people,” he said. “That was amazing.”

Chiacchia still has his horse farm in the thicket of Florida’s horse country. He’s grooming ten future champion horses and training young equestrians from all over the world, who in exchange help him out on the farm where he keeps an array of sheep, donkeys, chickens and dogs.

He’s always been a hustler, he said. Starting from the moment, when as a twelve-year-old delivering newspapers, he was first mesmerized by horses at the race track in Buffalo, New York, where he grew up. Since then, he’s tenaciously pursued his dreams—even in the face of the accusations.

His main concern with the HIV criminalization laws is that they empower accusations, he said.

“They also give people a false sense of security that someone wouldn’t do that,” meaning not reveal their HIV status. “Imagine a father telling his daughter not to worry whether she’s pregnant because it’s a guy’s responsibility.”

“The law suggests one’s sexuality is someone else’s responsibility,” he said. “People who don’t know their own status are the worst risk group.”

According to the CDC, 13 percent of HIV positive people in the U.S. over age 13 don’t know their status. Chiacchia said he wants to get more involved with education efforts now that the burden of his trial is over.

He’s acutely aware that most people with HIV similarly accused might not have had the resources to fight such a battle. HIV, especially in rural areas, disproportionately affects the poor.

“I’m an upper-middle class, white male, an Olympic athlete, living the American Dream, and this law almost took me down,” he said. “Think about all the other people out there.”

THE DEEP SOUTH: THE PERFECT STORM FOR HIV

AIDS activist Kathie Hiers remembers when the scope of the HIV/AIDS crisis in her home state of Alabama hit her. She was doing a home visit in Choctaw County, a deeply rural county with just under 14,000 inhabitants. Hiers was visiting a mother and her two daughters—all of whom were HIV positive. The older daughter was pregnant, and the younger one had pneumonia. The younger one sat facing the open oven door. She had a towel over her head to capture the heat, since they couldn’t afford to heat their home. A few weeks later, she died.

“Unfortunately, we just didn’t get her into care in time,” Hiers said, adding that all three women, who developed full-blown AIDS, had not been in regular care.

“They were sharing their medications with their boyfriends, thinking that would keep them from getting it. They weren’t getting the proper dosages,” Hiers added.

Poverty, lack of access to health care, pervasive stigma, racial inequalities and a high rate of STIs (sexually-transmitted infections)—which make it easier to transmit HIV—have made the rural South “the perfect storm for HIV,” Hiers said.

“Alabama is 50 percent plus rural, and it is exceedingly difficult to serve these people adequately,” Hiers added.

According to a recent report by the Center for Health Policy and Inequalities Research at Duke University, the South has had the highest number of HIV diagnoses for over a decade.

Of the 17 states comprising the South, the nine that make up the Deep South are particularly afflicted. In 2013, 40 percent of the country’s HIV diagnoses occurred in the Deep South, which accounts for only 28 percent of the U.S. population. The states in this region include Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

African-Americans in the South are also disproportionately affected by HIV. In 2013, 53 percent of the diagnoses in the Deep South were in African-Americans, compared to 44 percent in the U.S.

The Deep South has also traditionally had the highest death rates for people with HIV. Between 2008 and 2013, 43 percent of deaths in the U.S. attributed to HIV were in the Deep South, according to the report.

“You should not be dying from HIV in this day and age,” said Carolyn McAllaster, the Director of the Duke HIV/AIDS Policy Clinic. “If you’re on treatment, it’s a chronic illness with normal life expectancies. The folks who are dying are dying from inadequate care—late diagnosis, or not accessing care once they’ve been diagnosed.”

“The higher death rates are telling the story better than any number that we have,” she added.

Also, people with HIV in the rural Southeast were more likely to have an AIDS diagnosis within a year of being diagnosed with HIV, according to the report.

One of the problems is that rural areas in the South lack physicians. According to the report, 40 percent of HIV-specific providers are in the South, where 44 percent of the country’s HIV positive people are. Transportation issues also disproportionately affect people in rural areas. Some patients don’t have cars and can’t get to clinics—and they don’t want to ask for help lest people find out about their status.

“If they don’t have a car, stigma can kick in,” McAllaster said.

Stigma persists amongst providers as well, McAllaster added.

“Primary care providers do not want to prescribe PrEP because they think it will encourage risky sex,” she said. PrEP, or pre-exposure prophylaxis, is a preventive medication for people who are at substantial risk of HIV.

McAllaster likens likens the resistance to PrEP to the resistance to birth control pills because “they think she’ll sleep around.”

For similar reasons, sex education is not taught in schools in much of the South, which ultimately leads to unsafe practices, Hiers said. In Alabama, the number of young people with HIV has increased from one in four to one in three.

To overcome some of these hurdles, Hiers, the CEO of the nonprofit AIDS Alabama, has been working to get help and resources for HIV positive people in all of the state’s 67 counties. She started a telemedicine initiative so that people can be seen remotely—and privately.

“We’re learning that people would rather [our offices] not be located at health departments. A lot of peoples’ relatives work at the health department, and people are afraid of losing confidentiality,” Hiers said.

Local initiatives like this also help offset a disparity in funding at the national level for the rural South.

“A lot of the resources go to the big, urban areas,” McAllaster said. “A lot of our advocacy is around getting resources to the rural areas and smaller cities.”

Hiers added that certain urban areas like New York and San Francisco have almost ended the epidemic. “I tell my colleagues in bi-coastal areas that they will never end the epidemic in the U.S. without dealing with the South,” she said.

The updated National HIV/AIDS Strategy (NHAS) targets the South, with the goal of reducing HIV diagnoses by 25 percent within five years.

THE FUTURE OF HEALTH COVERAGE

Hiers breathed a sigh of relief when Trumpcare failed to pass in late March.

“Nothing about it was good for people with HIV,” she said, adding that the Affordable Care Act gave many HIV positive people a window of opportunity to access affordable healthcare and medications.

“Definitely the ACA helped people with HIV, even if they weren’t in states that expanded Medicaid,” she added. As an example, in Alabama—a non-expansion state—five percent of people with HIV signed up for the exchanges, she said.

In expansion states, Medicaid coverage for people with HIV increased six percent between 2012 and 2014 nationwide. In those same states, the uninsured rate of people with HIV dropped six percent, according to the Kaiser Family Foundation.

Haught said that the ACA also gave her access to more physicians.

“For the first time in twenty years, I was able to go to doctor five minutes from home, and I get all my medications from one source,” Haught said, adding that before the ACA, she would drive five hours round-trip just to see one doctor.

She is worried that any changes to the ACA will negatively affect people living with HIV.

“[Losing coverage] impacts adherence. If affects our lives. If we don’t get our medications, we will die.”

“I’ve seen that death,” she continued. “I wouldn’t wish it on anyone.”

While no one can predict the changes coming around the corner, one thing is certain for HIV activists:

“It’s not the right time to pull back in resources,” McAllaster said. “We’ve made some real advances in fighting this epidemic.”

Just a few days after the AHCA was sent back to the drawing board, activists were celebrating some of those advances—and advocating for more—at AIDS Watch. On March 28th over 650 people from 34 states gathered in Washington D.C. to educate members of Congress about their needs.

“I went to something that really choked me up,” Hiers said. “It’s a new wave of what’s coming.”

The presentation was called “Undetectable Equals: untransmittable,” and featured discussion of three major studies that have shown that HIV-positive people who are virally suppressed cannot transmit HIV. That knowledge should help revamp states’ criminalization laws, she said.

But the more profound impact might be an internal one to people living with HIV, she added.

“It was so moving to see HIV positive people change their perception of themselves. They don’t have to think of having sex as a loaded gun anymore. It’s really an encouragement for people to stay on theirs meds.”

Published in Rural Health Quarterly on May 12, 2017

US: Louisiana "AIDS exposure" law is outdated and perpetuates stigma

Is Louisiana’s ‘AIDS exposure’ statute outdated? Advocates say it adds to stigma

Richard Covington was accused earlier this year of breaking into the house of someone who apparently owed him money and then fighting the resident. During the scuffle, Covington allegedly bit the man’s arm.

In addition to a charge of home invasion, the Baton Rouge Police Department booked 48-year-old Covington on the charge of “intentional exposure to AIDS,” a statute added to the books in Louisiana in 1987.

East Baton Rouge Attorney Hillar Moore recently said his office isn’t pursuing the AIDS exposure charge against Covington, mostly because it’s difficult — if not impossible — to prove if a bite would threaten the transmission of HIV.

Mark Alain Dery, an assistant professor of clinical medicine at Tulane University who runs the school’s AIDS clinic in New Orleans, said the chance of a bite exposing someone to the virus that can lead to AIDS is “very, very highly unlikely.” The biter would have to have bloody gums and break the skin to affect blood-to-blood exposure.

Moreover, Dery said, the language in the statute Covington was charged with is “scientifically inaccurate,” and the law perpetuates harmful stigmas against people living with AIDS.

“You can’t transmit AIDS, period,” he said. “What’s transmitted is a virus.”

HIV is the transmittable virus that can spread from person-to-person. Acquired Immune Deficiency Syndrome, or AIDS, is a condition resulting from a low count of T-cells, which is caused by untreated HIV. T-cells are white blood cells that fight disease as part of the body’s immune response.

The law was written at a time, Dery said, when the science behind HIV and AIDS was “poorly understood, if understood at all.”

ACLU of Louisiana Executive Director Marjorie Esman said laws involving the “criminalization of HIV and AIDS” are problematic, and movements are afoot across the country to address them. In Louisiana, she said, advocates are in the early stages of looking into the best legislative solution.

Esman noted that with advances in medicine, people with AIDS and people who are HIV-positive can “live very long lives” if the virus is properly treated. Dery said patients who treat their HIV with medication sometimes effectively lower their viral loads so they become undetectable, though there is still some risk of transmission.

“At one time, full-blown AIDs was a death sentence,” Esman said. “It’s not anymore.”

AIDS and HIV laws were adopted in the 1980s and early 1990s amidst a fear of the growing, seemingly lethal condition that had limited remedies at the time, Dery said. Now that AIDS is less deadly than once feared, the existing laws are “far more punitive” than they should be.

Moore, who serves as president of the Louisiana District Attorney’s Association, said there are potential scenarios in which it might be appropriate to apply the statute, including those when prosecutors can prove someone intentionally and successfully transmitted the virus.

He said, however, that the “vast majority” of cases they’ve received from police involving the charge “have been non-prosecutable.”

“Officers and deputies are just not familiar with the science and what is actually considered (when applying) the statute,” Moore said.

Baton Rouge Police Department spokesman Cpl. Don Coppola said in an interview last month that officers will continue to enforce the AIDS exposure law as it’s written. He added, though, that the department’s legal division is diligent about updating officers regarding changes to or constitutional problems with existing laws.

Another case involving Louisiana’s AIDS statute surfaced in August in St. James Parish, where authorities allege 31-year-old Barlon Cammon intentionally exposed a teenage victim to HIV. He was also booked on a charge of carnal knowledge of a juvenile.

In February, A Baton Rouge man was arrested after his girlfriend allegedly told Baton Rouge police her live-in-boyfriend exclaimed during an altercation, “That’s why I gave you AIDS.” Norris Wyatt, then 38, was charged with intentional exposure to AIDS. He was already on probation at the time for the same charge stemming from a previous incident.

The statute has also been used at least seven times over the 10 or so years in East Baton Rouge Parish when the arrestee was accused of spreading HIV by spitting, according to a 2014 report from The Advocate. Even though the statute specifically defines spitting as a “means of contact,” under which the law can apply, Dery — along with the U.S Centers for Disease Control and Prevention — note that HIV is not transmitted through saliva.

Dery noted that police sometimes tack the “AIDS exposure” charge onto a list of other charges, which can drive up jail bonds or grabs news media headlines, even if the charge is never prosecuted.

“The gross lack of confidentiality violates all medical ethics and public health practice standards,” he said.

He further noted that criminalizing AIDS and HIV adds to the stigma of shame for those living with the virus or condition. “It drives people from knowing what their status is, from getting HIV tested.”

Perpetuating the AIDS stigma, then, could have dangerous consequences: One in five people who have HIV don’t know they have it, Dery said. And those 20 percent are believed to be responsible for between 60-to-80 percent of HIV transmissions.

Noting that New Orleans and Baton Rouge populations are among those with the highest rates of AIDS in the country, Esman said the state should shift its focus regarding its treatment of people living with HIV or AIDS.

“Arresting people makes no sense,” she said. “What we need to be doing is treating people who are sick.”

Moore said the law could possibly “use some tweaking.” He indicated the district attorney’s association would be open to a proposal amending parts of the statute.

 

Emily Lane is a news reporter based in Baton Rouge. Reach her at elane@nola.com or 504-717-7699. Follow her on Twitter (@emilymlane) or Facebook.
Published on May 17, 2017 in Nola News.

 

US: Indiana Law on HIV non-disclosure criminalises people who have no intention of harming another person

Travis Spoor sits in the Kosciusko County Jail, accused, again, of failing to tell his sexual partner that he is HIV-positive.

The 37-year-old is facing malicious mischief charges in three counties for leaving his partners exposed to the disease without their knowledge. He faces up to two and a half years in prison on each charge.

According to court documents, at least two of his sexual partners found out about Spoor’s HIV status through a news article.

Spoor’s mother, Lisa Holderman, broke down in tears as she said her son isn’t a criminal.

“He’s lost his children. He’s lost his job. He’s lost insurance. He’s lost his home. He’s lost his car,” Holderman told the crowd attending HIV Advocacy Day last month at the Statehouse. “We’re losing everything just to try to get my son out of jail.”

Indiana has several laws that impact the lives of people infected with HIV. In addition to being required to inform sexual partners, they can face penalties for exposing people to any bodily fluid, even those that do not transmit HIV.

Carrie Foote, IUPUI professor and co-chair of HIV Modernization Movement, argues these state laws are outdated and research shows they don’t prevent the spread of the disease. Instead, they can discourage people from getting tested.

In Spoor’s case, Foote doesn’t believe he intended to harm his partners. She compared Spoor’s actions to contraceptive fraud.

“There are things that can cause life changing events in adult sexual decision making that we don’t criminalize in that way,” Foote said.

Foote, along with the HIV Modernization Movement, is working to modernize or repeal a few of the current HIV laws that she argues turns the disease into a crime.

But to describe it as criminalizing is completely inaccurate in the eyes of Terre Haute based Vigo County Prosecutor Rob Roberts.

“It doesn’t do the criminal justice system any service and it certainly doesn’t do HIV people any service to try and scare them to think that they might be prosecuted just for having HIV,” Roberts said.

During his career, Roberts has prosecuted only one HIV case to completion. He said bringing charges against an HIV-positive person for their actions is rare.

Roberts argued the state punishes other behaviors that put people at risk.

“Criminal Recklessness — where you may be reckless in your actions in driving a vehicle or in discharging a firearm and you have put other people at risk in those situations,” Roberts said. “We criminalize those actions because it’s the action that we’re talking about, not the status of someone being behind the wheel of the vehicle or possessing a firearm.”

However, Roberts thinks it’s a possibility that disclosure laws are one of the reasons why people don’t get tested in the first place.

Conquering Stigma

At the Damien Center in Indianapolis, more than 4,000 infected individuals receive care and services from Indiana’s oldest and largest AIDS service organization. For years, Jeremy Turner, director of development and communication at the center, has helped get people tested for HIV.

“Disclosure is the right thing to do, but unfortunately HIV is so heavily stigmatized because of things like duty to warn and because of legislation that might not be fair to them, but also because of the social implications of being HIV positive,” Turner said. “Disclosure is a hard thing to do.”

Stigma is one of the biggest hurdles in ending the HIV epidemic, Turner said, and that’s exactly what the current HIV laws do, according to Foote.

The HIV Modernization Movement’s main goal is to modernize the duty to warn and battery by bodily waste HIV laws. Duty to warn is the law that requires HIV-positive people to reveal their condition to sexual partners and needle-sharing partners. The battery by bodily waste law applies to a range of acts and bodily fluids, including spitting or throwing feces.

For Foote, the main problem with the duty to warn law is that it charges people who have no intention of harming another person. She wants the law revised to require proof that the person had intent to harm.

“The way these laws are worded, if I was sexually assaulted, I would have to disclose to my rapist that I was HIV positive,” Foote said. “There’s nothing in the law that tells that I don’t have to do that.”

The movement is also pushing to repeal the laws that prevent HIV positive people from donating blood or semen altogether. Foote said there’s no risk of transmission if a man with HIV was to seek fertility services. Additionally, the Food and Drug Administration screens blood donations for the disease.

 Understanding the laws

Results of a recent survey of health care providers about HIV disclosure showed that the majority of respondents had little understanding of the law or the consequences. Only 58 percent of the more than 170 respondents said they read the full Indiana duty to warn code and only 43 percent knew the punishment for law breakers.

Those health care providers are the ones to make sure patients sign a form acknowledging that they have a duty to disclose their condition to partners past and present.

John Coberg II, an IUPUI research assistant who worked on the survey along with Foote, said he saw a common theme in the results — that the laws are harmful.

In the survey one anonymous provider wrote, “It often makes the client feel like a criminal, or they’re dirty or wrong when they’re in my office for help. As a care coordination person, you should never want your client to feel any of these things when they walk in your office.”

Changing the laws

When changing a law, Roberts said two questions need to be considered: How is the statute being used, and is it being used in an unfair fashion? In Roberts’ opinion, these laws haven’t been around long enough to answer these questions just yet.

Roberts said it’s the job of the legislature to look at the current laws to see if they need tweaking.

“We can take a look,” Sen. Greg Taylor, D-Indianapolis, said.

Taylor’s focus is the current battery by bodily waste law, since research shows HIV is not transferrable by saliva. He wants to change the law so that HIV positive people aren’t charged differently for having the disease.

“If the chairman of the health committee is willing to go along with it, we can hopefully put some modern legislation in place to protect the public but also not make a criminal out of people because they contracted HIV,” Taylor said

Published in NUVO on May 12, 2017

Norway: Activists concerned about latest proposals to change Norway's HIV law

Critical to changes in section 237 of the Criminal Code

Reidar Engesbak, April 26, 2017

(Google translation from http://blikk.no, original post below)

The government last week presented a proposal – Prop. 120 L (2016–2017) – for penalties on transmission of infection and endangered spread of infection.

The Ministry of Justice’s submitted to the Storting a proposal for amendments to section 237 of the Criminal Code, which mainly follows the recommendations of the statutory committee that were appointed on the basis of criticism of the current criminal law regulation.

The law committee resulted in the NOU “About Love and Cooling Tower – Criminal Justice in Major Infectious Diseases.”

“I am pleased that we now propose a regulatory framework that addresses the medical development,” said Per-Willy Amundsen, Deputy Minister of Justice, in a press release.

The proposal entails, among other things, clarification that criminal liability is not imposed when appropriate contingency measures have been observed. This includes, among other things, successful medical treatment of HIV infection. Emphasis has been placed on the fact that the knowledge base on the treatment of HIV infection has changed in recent years and that the infection risk from well-treated HIV-positive individuals must be considered minimal.

The government also proposes a change in the Criminal Procedure Act, which allows the police to routinely investigate the infectious status of persons suspected of rape or other serious sexual assault.

“The proposal means that we can be clarified faster than today if the victims have been exposed to a risk of infection. It is important for the government to strengthen the offender’s position in criminal matters, and this change will contribute to that, “Amundsen said in the press release.

Contrary to UNAIDS ‘recommendations

The user organization New Plus – Hivpositives National Association is not so excited. The proposals, according to New Plus’s view, involve a number of things that will worsen the legal situation of those living with HIV.

“What is positive with the bill is that it is suggested that you can not prosecute people who have been negligent and that it is now necessary to commit gross negligence in order to be prosecuted,” said Kim Fangen, Managing Director of New Plus.

New Plus nevertheless believes that the boundary is still unclear. “It is still not the case that actual transmission of infection will be required in order to be punished. Consequently, the provision will still violate UNAIDS ‘recommendations, which state that punishment can only be used where there is a person who is aware that he or she has HIV or with the knowledge and willingness to infect another and infection is actually transmitted.

A little impractical

The proposition is for people to be treated for successful treatment to be exempted from punishment. It’s a suggestion New Plus applaudes. “However, the proposal implies that one can only be exempted from punishment after successful treatment and has been with his partner for prior infection prevention guidance from healthcare professionals, as well as the consent of the partner after this. This scheme applies today only to persons living in marriage or marriage-like relationships. The Ministry therefore wishes to extend the personal circle that will be covered in principle, it will apply to all,” said Fangen to Blikk Nett.

New Plus believes the scheme is impractical. “We can hardly see for ourselves that you want to bring a man for two weeks to the GP to get such consent. It will soon become most relevant for those who have been together for so long that one will nevertheless be covered by today’s wording about marital-like relationships. In any event, this means that an obligation to inform sexual partners is forced for persons who are nevertheless not infectious. People who are on successful treatment will not be able to transfer infection to others, says Fangen, and refers to statements by Professor Jens Lundgren at Rigshospitalet in Denmark.

“When you know at the same time how little knowledge exists in the society about HIV, this means that you can quickly find yourself in a very vulnerable situation to those you want to have sex with, without even jeopardizing the other.

Increased penalty frame

The Ministry of Justice’s proposal also wishes to raise the penalty frame for gross negligence from 3 to 6 years through a new provision in the Act. “This is very serious because it sends a signal about the severity of these actions and could make it even more stigmatizing to live with HIV,” Kim Fangen points out.

“We know that most infections occur when the person who has the virus does not even know that they are infected. These penalties will continue to hit people who have, in their ignorance, exposed others to infectious persons and people who can not actually infect anyone, but because they have not been open about status and conducted infectious guidance can be punished nevertheless. This is believed to mean that fewer will be open about HIV status and that people living with HIV will feel further stigmatized, “said Kim Fangen to Blikk Nett.

“We therefore see no reason to cheer over this and will continue the fight to completely decriminalize HIV.

Kritisk til endringer i Straffeloven § 237

Regjeringen la forrige uke fram et forslag til straffebestemmelser om smitteoverføring og allmennfarlig smittespredning.

Justisdepartementets proposisjon (Prop.120L) til Stortinget et forslag til endringer i Straffelovens paragraf 237, som i hovedsak følger opp anbefalingene til lovutvalget som ble oppnevnt på bakgrunn av kritikk mot den gjeldende strafferettslige reguleringen.

Lovutvalget resulterte i NOU-en «Om kjærlighet og kjøletårn — Strafferettslige spørsmål ved alvorlige smittsomme sykdommer.»

– Jeg er fornøyd med at vi nå foreslår et regelverk som tar opp i seg den medisinske utviklingen, sa justis- og beredskapsminister Per-Willy Amundsen (FrP) i en pressemelding.

Forslaget innebærer blant annet en klargjøring av at straffeansvar ikke pådras når forsvarlige smitteverntiltak er iakttatt. Dette omfatter blant annet vellykket medisinsk behandling av hivsmitte. Det er lagt vekt på at kunnskapsgrunnlaget om behandling av hivsmitte har endret seg de siste årene, og at smitterisikoen fra velbehandlede hivpositive personer må anses som minimal.

Regjeringen foreslår også en endring i straffeprosessloven som åpner for at politiet rutinemessig kan undersøke smittestatusen til personer som er mistenkt for voldtekt eller andre alvorlige seksuelle overgrep.

– Forslaget innebærer at vi raskere enn i dag kan få avklart om fornærmede har blitt utsatt for smittefare. Det er viktig for regjeringen å styrke fornærmedes stilling i straffesaker, og denne endringen vil bidra til det, sa Amundsen i pressemeldingen.

Strider mot UNAIDS’ anbefalinger

Brukerorganisasjonen Nye Pluss – Hivpositives landsforening er ikke så begeistret. Forslagene innebærer etter Nye Pluss sitt syn en rekke ting som vil forverre den juridiske situasjonen for de som lever med hiv.

– Det som er positivt med proposisjonen, er at det foreslås at man ikke kan straffeforfølge personer som bare har vært uaktsomme, og at det skal nå kreves grov uaktsomhet for å kunne straffeforfølges, sier Kim Fangen, daglig leder i Nye Pluss.

Nye Pluss mener likevel at grensegangen fortsatt er uklar.

– Det er fortsatt ikke slik at faktisk smitteoverføring vil kreves for at man skal kunne straffes. Følgelig vil bestemmelsen fortsatt stride mot UNAIDS’ anbefalinger, som statuerer at straff bare kan brukes der det er snakk om at en person enten er klar over at hen har hiv, eller med viten og vilje går inn for å smitte en annen og smitte faktisk overføres.

Lite praktisk

Proposisjonen går inn for at personer på vellykket behandling skal fritas fra straff. Det er et forslag Nye Pluss applauderer.

– Forslaget innebærer dog at man bare kan fritas fra straff om man er på vellykket behandling og har vært med sin partner til forutgående smittevernveiledning hos helsepersonell, samt fått samtykke fra partneren etter dette. Denne ordningen gjelder i dag bare for personer som lever i ekteskap eller ekteskapslignende forhold. Departementet ønsker dermed å utvide personkretsen som vil omfattes til at den i prinsippet vil gjelde alle, sier Fangen til Blikk Nett.

Nye Pluss mener ordningen er lite praktisk.

– Vi kan vanskelig se for oss at man vil ta med seg en man har datet i to uker til fastlegen for å få et slikt samtykke. Det blir fort mest aktuelt for de som har vært sammen såpass lenge at man uansett vil dekkes av dagens ordlyd om ekteskapslignende forhold. Uansett betyr dette at man tvinger frem en informasjonsplikt overfor seksualpartnere for personer som uansett ikke er smittefarlige. Personer som er på vellykket behandling vil ikke være i stand til å overføre smitte til andre, sier Fangen og viser til uttalelser fra professor Jens Lundgren ved Rigshospitalet i Danmark.

– Når man samtidig vet hvor lite kunnskap som finnes i samfunnet om hiv, gjør dette at man fort setter seg i en veldig sårbar situasjon overfor de man vil ha sex med, uten at man selv utgjør noen fare for den andre.

Økt strafferamme

Justisdepartementets proposisjon ønsker i tillegg å heve strafferammen for grov uaktsomhet fra 3 til 6 år gjennom en ny bestemmelse i loven.

– Dette er svært alvorlig fordi det sender et signal om alvorlighetsgraden av disse handlingene og vil kunne gjøre det ytterligere stigmatiserende å leve med hiv, påpeker Kim Fangen.

– Vi vet at de fleste smitteoverføringer skjer der personen som har viruset ikke selv vet at hen er smittet. Disse straffebestemmelsene vil forsette å ramme personer som i sin uvitenhet har utsatt andre for smittefare og personer som i realiteten ikke kan smitte noen, men som fordi de ikke har vært åpne om status og gjennomført smitteveiledning vil kunne straffeforfølges likevel. Dette tror vi vil medføre at færre vil være åpne om hivstatus og at personer som lever med hiv vil føle seg ytterligere stigmatisert, sier Kim Fangen til Blikk Nett.

– Vi ser dermed ingen grunn til å juble over dette og vil fortsette kampen for å avkriminalisere hiv fullstendig.

US: HIV criminalisation laws are outdated, stigmatising and applied unfairly and it’s time to end the cycle says Erika D. Smith

The AIDS crisis is over. Why are people still going to jail over HIV? 

BY ERIKA D. SMITH

I’m not in the habit of quoting Ronald Reagan. But on Monday, as legislation that would greatly reduce the criminal penalties for transmitting HIV moved one step closer to a vote in the California Senate, I couldn’t help but think of words penned by the former president.

The year was 1990 and my teacher handed out a Washington Post article for the class to read.

“We owe it to Ryan to make sure that the fear and ignorance that chased him from his home and his school will be eliminated,” Reagan wrote. “We owe it to Ryan to open our hearts and our minds to those with AIDS. We owe it to Ryan to be compassionate, caring and tolerant toward those with AIDS, their families and friends.”

He was reacting to the death of Ryan White, a blond-haired boy from the Midwest who had contracted HIV during a blood transfusion for hemophilia and was diagnosed with AIDS. White wasn’t like the then-mysterious gay men in California and New York, or even the IV drug users in inner cities, who had been falling ill and dying by the thousands. He was an “innocent” victim.

At 13 years old, he got thrust into the national spotlight because he wanted to go to school with his friends. But because it was the height of the AIDS epidemic, an era when fear and willful ignorance regularly trumped facts, the school district fought his family at every turn.

As a 13-year-old girl in a Midwestern suburb, I identified with him.

Over time, that vague fear of AIDS that I once had has been replaced with an understanding that HIV is a chronic illness that can be easily managed with medication. It’s no longer a death sentence. What’s more, it’s highly unlikely that someone with an undetectable level of HIV in his or her blood, which is pretty common these days for undergoing treatment, will transmit the virus to anyone else.

Heck, hepatitis C kills three times as many people as HIV does.

But in California and more than 30 other states, dozens of laws remain on the books to punish people who willfully expose others to the virus. To this day, people still get charged with felonies over HIV and go to prison for five, 10 or even 20 years. In some states, those convicted must register as a sex offender for life.

These laws aren’t “compassionate,” “caring” or “tolerant” toward people with HIV or AIDS. They’re fear-based holdovers from the days of the “gay plague,” which in many ways, the Reagan administration callously let happen by ignoring the disease and its victims for far too long. Back in the 1980s, Reagan wasn’t “compassionate,” “caring” or “tolerant.”

San Francisco was ground zero, with three times as many AIDS cases per capita as New York and 10 times as many as Los Angeles. At one point, about half of San Francisco’s gay men were infected and most expected to die within 10 years. I’ve heard horror stories from gay men with gray hair, many of them tearing up just thinking about all the friends and partners they lost.

So it’s telling that it’s a gay man from San Francisco, Sen. Scott Wiener, who is pushing the bill that would greatly reduce the penalties for transmitting HIV.

Where California now has four felony offenses on the books for people who deliberately pass along the virus, Senate Bill 239 would repeal two of them and reduce two others to a misdemeanor, just like the intentional transmission of every other infectious or communicable disease.

The bill advanced out of the Senate Appropriations Committee on Monday and Wiener hopes to get it to the Senate floor by May or June.

So far, only the California Right to Life Committee has come out in opposition. Meanwhile, the list of groups in support is long, from the California Medical Association to Equality California to the ACLU.

Their reasoning is pretty plain. One is that threatening to punish people for transmitting HIV does absolutely nothing for public health. It only encourages people to hide their status or not get tested at all. You can’t be charged with infecting someone with something you didn’t know you had.

Another reason is that research shows that the laws are applied unfairly. White men, for example, make up 40 percent of the people diagnosed with HIV in California, but only 16 percent of the individuals who’ve had contact with law enforcement over it, according to the Williams Institute at UCLA.

Meanwhile, black women make up only 4 percent of the Californians diagnosed with HIV, but account for 21 percent of people who have gotten in trouble for it. A good number of them are sex workers, turning a potential misdemeanor prostitution charge into a felony.

Only about 1,260 people were accused of an HIV-related crime in California between 1988 and 2014. Of those who were convicted, 85 percent were sent to prison.

So far, only Iowa and Colorado have acted to repeal their laws. If California is next, it could potentially accelerate a fledgling national trend toward decriminalization.

There’s little hope of accomplishing change at the federal level, even though public health officials have been pushing for it for years. In Congress, Reps. Barbara Lee, D-Oakland, and Ileana Ros-Lehtinen, R-Fla., introduced the Repeal HIV Discrimination Act, but it’s likely to go nowhere. There has been resistance, particularly among Republicans.

Like the Reagan administration, red state lawmakers started paying attention to AIDS because of Ryan White, a boy unfairly marginalized by people who didn’t understand HIV or how it is contracted. Following an early provision in the Ryan White Comprehensive AIDS Resources Emergency Act, which provided funding for education and treatment, they passed misguided laws to prosecute people over HIV or AIDS.

California just beat middle America to the punch.

Now the remnants of those laws are being used to marginalize a whole new group of people with HIV, many of them opioid addicts in red states spreading the virus through dirty needles. It’s time to be “compassionate,” “caring” or “tolerant.” It’s time to end the cycle.

Published in the Sacramento Bee on April 24, 2017

US: Fact sheet from the Williams Institute summarises all we know about HIV criminalisation in California

This fact sheet from The Williams Institute highlights significant findings from its research on HIV criminal laws in California. Conduct criminalized includes condomless anal or vaginal sex with intent to transmit HIV and without HIV status disclosure, as well as donation of blood, tissue, semen, or breast milk for people living with HIV (PLHIV) who know their HIV status. It also enhances the criminal penalty for PLHIV convicted of solicitation and for sexual assault crimes.

Particularly notable findings include that:

• 98% of convictions required no proof of intent to transmit HIV;

• 93% of convictions required no proof of conduct that is likely to transmit HIV;

• HIV criminal statutes disproportionately affect women, people of color, and immigrants living with HIV, and they are disparately enforced based on race/ethnicity and gender; and

• felony solicitation enforcement has disproportionate impact on LGBTQ youth and transgender women of color.

HIV Criminalization in CA- What We Know.pdf

 

US: Michigan candidates for the governor's office call for State's HIV felony law to be repealed

Dem Gubernatorial Candidates Call for Reform of State’s HIV-Specific Law

Advocates Applaud Move, Encourage Legislative Action Before New Governor Takes Office in 2019

LANSING – Calling Michigan’s HIV-specific felony law “discriminatory” and “wrong to criminalize sickness,” the two declared candidates for the governor’s office say it’s time to reform the law.

“I’m a strong believer in science, and in the years this law has been on the books, significant strides have been made in HIV treatment and prevention,” said Gretchen Whitmer, the former State Senate Minority Leader and Ingham County Prosecutor. She’s declared her candidacy for the Democratic nomination for governor in 2018 earlier this year. “Yet prosecutions are often driven by fear and stigma, not science, just as the legislation itself was when it was passed. It’s wrong to criminalize sickness, which is what this law has effectively done. It absolutely should be revisited.”

Last month, Abdul El-Sayed, the former director of the City of Detroit’s Department of Health and Wellness Promotion, told Between The Lines that Michigan’s law “absolutely” should be repealed.

“You should not be criminalized for a disease,” he said. The 32-year-old doctor was a Rhoades Scholar and in his role as the director of Michigan’s most populous city’s health and wellness promotion, he dealt first hand with the ongoing HIV crisis in Detroit. “That is absolutely wrong. It’s hateful. It’s discriminatory, and we can, as a state, do better. You can count on me for that.”

Michigan passed the AIDS-Penetration with Uninformed Partner Law in 1988. Former lawmaker Susan Grimes Gilbert (formerly Grimes Munsell) lead the charge to pass Michigan’s law as well as participated in the American Legislative Exchange Council (ALEC) working group on the subject. That group recommended the development of HIV Assault laws in all 50 states

In an interview presented in a report in The Advocate and The American Independent News Network in 2013, she acknowledged that the law was driven by fear.

“At that time people were scared to death of [AIDS],” Grimes Munsell told the news outlets. She acknowledged much had changed since that time.

“I think it is time to repeal the [felony] law,” she said in 2013. “In fact, I don’t do this very often, but I am willing to lobby for that change.”

Her voice added to an already growing chorus calling for reform. Among them, the former staffer from ALEC who wrote the group’s draft legislation and policy recommendations and a member of President Ronald Reagan’s Commission on HIV, commonly called “The Watkins Commission.”

Social scientists and activists have criticized the laws for years as unfairly stigmatizing those living with HIV as people hell bent on transmitting their infection to others. They’ve noted the laws have little impact on behavior and at least one study has found that high profile prosecutions for HIV nondisclosure lead those most at risk of HIV infection to decline HIV testing and sexual health counseling from healthcare providers.

State Rep. Jon Hoadley (D-Kalamazoo) has been floating draft legislation for the last six months to modernize Michigan’s HIV law. Specifically, his proposal would eliminate the current felony law, and create in its stead two misdemeanor laws.

Both misdemeanor laws would require prosecutors prove beyond a reasonable doubt the accused not only had HIV, but intended to transmit the infection and took actions that had a likelihood of transmitting the virus. The lower of the two misdemeanors -which would carry up to 93 days in jail – would be used if there was no transmission. The one-year misdemeanor would be used if there was transmission of the virus.

The legislation garnered a number of co-sponsors last session, but Hoadley did not introduce it.

Activists supporting modernizing Michigan law say they are pleased the two Democratic gubernatorial candidates are raising the issue.

“We are very pleased to see the issues related to the unjust, unscientific law criminalizing HIV being taken up by candidates for the top office in the state,” says Kelly Doyle, the coalition manager for the Michigan Coalition for HIV Health and Safety. “This is about fairness and reducing stigma, and having top candidates talking about this issue helps reduce the stigma and highlight the problems.”

She was joined in that praise by Curtis Lipscomb, executive director of LGBT Detroit. He released a statement to BTL saying his group was “pleased” that the candidates “reject Michigan’s outdated HIV criminalization laws and the notion of criminalizing disease.”

“We must get rid of stigma around HIV/AIDS, testing, prevention and treatment – and listening to science is the only way to do that,” Lipscomb said.

He said his group is eager to continue discussions with the legislature “to move to repeal this dangerous law.”

Doyle echoed that sentiment, “Of course, this legislature could check one item off the beginning of the 2019 gubernatorial term by passing legislation now which brings Michigan in line with common sense public health approaches which ensure of the safety of all Michiganders.”

Published in PrideSource on April 13, 2017

Canada: Alison Carter explores the negative consequences of HIV Criminalisation on women living with HIV

The Politics Of Sex For Women Living With HIV

“If I have sex, I could go to jail.”

This is the reality of life for women living with HIV in Canada.

It’s a story I heard a few weeks ago from an African woman who had recently immigrated to Vancouver and is now faced with the profoundly isolating experience of being a Black HIV-positive woman in Canadian society.

This may come as a surprise to anyone unfamiliar with HIV in Canada: Women (and men) who are living with HIV are at risk of facing a criminal charge of aggravated sexual assault for not disclosing their HIV status before engaging in consensual sex, unless they have a low HIV viral load and use a condom. Beyond serving jail time, those convicted must register as a sex offender, a title usually reserved for child molesters and rapists. “That follows you around forever,” says a woman who was herself imprisoned for HIV non-disclosure.

This woman, and many others, bravely spoke out about their experiences of being treated like a criminal for living with HIV at the annual Canadian Conference on HIV/AIDS Research, held in Montréal from April 6 to 9.

The conference included a special session on the criminalization of HIV non-disclosure, which covered a broad array of issues ranging from data on the total number of charges laid, to women’s personal testimonies of feeling ‘under surveillance’, to the latest research findings on how the law is understood and experienced by thousands of women living with HIV across Canada.

Saara Greene of McMaster University, Angela Kaida of Simon Fraser University, and Marvelous Muchenje of the Canadian Coalition to Reform HIV Criminalization co-hosted the event in partnership with HIV-positive women, which brought together dozens of community leaders, scientists, lawyers, and activists from around the country.

“Some women are suffering in silence and they don’t know what the law says,” said Muchenje.

“The law assumes that sex takes place between partners of equal power,” added Greene. “And it wholly ignores what causes women not to disclose their status, including widespread stigma and violence that are both systematically targeted at women living with this disease.”

The women who have participated in their research, which involved telling stories through participatory arts-based Body Mapping, say “disclosure is not always safe or positive for women’s health and safety.” And for many, the fear of being abused, rejected, or worse jailed, is a significant barrier to even thinking about the idea of getting involved with someone.

Eighteen women have been charged for HIV non-disclosure in Canada, many of whom come from marginalized backgrounds and are survivors of sexual violence.

“Beyond the number of prosecutions, however, is the threat of prosecution,” said Kaida. “And this threat compromises both women’s interactions with healthcare providers and their sexual health.”

Kaida analyzed survey data collected from over 1000 women living with HIV in Canada, and found that for most women (65 per cent), the law affects the amount and type of information they are willing to share with providers, particularly as it relates to their sexual lives.

Kaida also found that 51 per cent of women were not having sex and of these, 78 per cent were intentionally abstinent. Women’s reasons for intentional abstinence were diverse though many (33 per cent) worried about HIV criminalization and disclosing their status to sexual partners.

“Laws criminalizing HIV non-disclosure have been defended as a means of protecting the sexual well-being of women,” Kaida said. “However, our findings show women are protecting themselves from the law by intentionally abstaining from sex.”

It goes without saying that women living with HIV shouldn’t have to live in fear of having sex. Sex is a normal part of life. It feels good. It has health benefits. And it’s a human right, one that this law violates.

The law also ignores groundbreaking new science that shows a person with HIV who is on treatment with undetectable levels of the virus in their blood has zero chance of passing HIV to their sexual partners. Put simply, Undetectable=Untransmittable.

Wedged in between science, on the one hand, and society on the other, are decades of cultural discourses of risk, danger, and stigma.

Stigma is a dangerous construct. It deters people from accessing testing and treatment. It leads to anxiety, depression, isolation, and loneliness. And it creates a social and legal environment that fosters abuse, harassment, and discrimination against women living with the condition.

In the face of a mountain of evidence of medical advances and human rights violations, many people are calling (shouting, really) for policy markers in Canada to update the laws and de-criminalize HIV. Doing so would also help to de-stigmatize sex for women living with HIV.

“The discrimination I face because of I live with HIV is ridiculous,” says Peggy Frank, an openly positive woman and researcher. “It’s a small virus that has little to do with who we are. I am a human being and I have the rights that every other human being has, and that includes sex.”

Allison Carter is a feminist epidemiologist conducting sex-positive research with women living with HIV. She is working with women on building a new online resource, called Life and Love with HIV, dedicated to building conversation and community around sexuality and relationships for women and couples with HIV around the world. Sign up to be notified when the website launches.

Published on April 10, 2017 in the Huffington Post

 

US: Updates on 4 states that may reform HIV Criminalisation laws

What’s New in HIV Criminalization in the United States: Congress, California, Florida, Georgia, Ohio and Utah

By Victoria Law

From TheBody.com

April 6, 2017

Table of Contents

Will Congress modernize HIV laws and policies? Advocates certainly hope so. Here’s an update, plus a look at four states that may reform laws that criminalize HIV non-disclosure and transmission — and one state that’s increasing penalties for people living with HIV.

REPEALing Policies That Encourage and Allow HIV Discrimination

On the federal level, Congress is considering HR 1739 or the REPEAL HIV Discrimination Act of 2017. If passed, the Act directs the attorney general, the secretary of Health and Human Services and the secretary of defense to initiate a national review of federal (including military) and state laws, policies, regulations and judicial decisions regarding criminal and related civil commitment cases involving people living with HIV or AIDS. This last part means that, if it were passed, federal agencies (including all branches of the military) would review past HIV cases and decisions based on current knowledge about HIV transmission.

“We’ve got incredible science data. Now we’ve got to get policymakers to understand,” Ken Pinkela, the military and federal policy director for the Sero Project, told TheBody.com. Though the Act would not force states to follow suit, having a mandate on the federal level would influence policies on the state level. Furthermore, not only would Pinkela personally benefit if the REPEAL Act were passed, but so would every other member of the military who has been criminalized and discharged because of their HIV status.

California Looks to Reduce HIV Criminalization

In February, California state lawmakers introduced SB 239. The bill reduces HIV transmission from a felony with three, five or eight years in prison to a misdemeanor with jail time of no more than six months.

The bill also lessens penalties for people engaged in sex work. Currently, if a person is convicted of prostitution or another sexual offense, he or she is subject to an HIV test. If this person tests positive and is later arrested again for prostitution or another sexual offense, existing law makes them guilty of a felony. The bill deletes both of these provisions, meaning that people arrested for sex work are no longer required to submit to an HIV test and, if they are arrested again, they are not subject to a felony based on HIV status.

SB 239 also requires any court or agency that has records related to the deleted provisions to destroy them by June 30, 2018. Finally, the bill requires a court to vacate related convictions.

“These [existing] laws are disproportionately used against women and people of color, and fuel stigma, violence and discrimination,” stated Naina Khanna, executive director of the Positive Women’s Network – USA, when the bill was introduced.

The numbers prove this. Nearly half (43%) of those criminalized under California’s HIV-specific criminal laws are women, though women make up only 13% of Californians living with HIV. Though blacks and Latinx people make up only half of Californians living with HIV, they are more than two-thirds of those who came into contact with the criminal justice system based on their HIV status. The intersections have hit black women particularly hard. They comprise 4% of the state’s HIV population, yet make up 21% of those with criminal justice encounters because of their status. In contrast, white men, who make up 40% of people in the state diagnosed with HIV, compose 16% of those who encounter the criminal justice system because of their HIV status.

The bill passed the Senate’s Public Safety Committee by a vote of 5 to 2. It is now before the Appropriations Committee.

“Florida Doesn’t Want to Be First in New HIV Cases”

Under Florida law, it’s a crime to not disclose HIV status prior to sex. This was how [65-year-old Gary Debaun was arrested and charged with unlawful sexual transmission of a disease. Prosecutors charge that Debaun forged medical records declaring that he was HIV-negative to show to his then-partner. Under current law, creating a false report to hide the presence of HIV or other communicable diseases is a third-degree felony]].

Debaun’s attorney attempted to use another outdated law to prevent his conviction — that since Florida law defines sex as between a man and a woman, “sexual intercourse” only applies to heterosexual sex. Though a lower court agreed and dismissed the case, the state’s appellate court overturned that ruling. In March, the state’s Supreme Court also rejected that argument. The district attorney’s office has stated that it plans to re-introduce the charges.

However, the law may be changing. In March, the Senate Criminal Justice Committee voted unanimously in favor of SB 628, which updates existing HIV criminalization laws. If passed, a person with HIV would no longer be considered acting with intent to transmit if he or she were undergoing treatment, used a condom or other method to prevent transmission or had offered to do so (even if the offer was rejected by the other person). The bill would also reduce non-disclosure in other instances and the creation of a false report to hide HIV status from a felony to a first-degree misdemeanor.

“Florida doesn’t want to be first in new HIV cases; we want to be first in the effort to end the HIV epidemic,” said Senator Rene Garcia, the bill’s chief sponsor. Thanking service providers and advocacy groups such as the AIDS Healthcare Foundation and the Sero Project, he stated, “Today’s unanimous vote by the Senate Criminal Justice Committee is an important step.” The bill is now in the Health Policy Committee.

Georgia Convenes a Committee

Under current Georgia law, a person living with HIV or hepatitis can be arrested and sentenced to up to ten years in prison if they do not disclose their status before having sex, sharing needles or donating blood. If a person with HIV or hepatitis throws bodily fluids (such as urine, blood, feces or saliva) on a peace officer or correctional officer, they face up to 20 years in prison. It does not matter that spit does not transmit. Over 50,000 Georgians live with HIV and approximately 3,000 are newly diagnosed each year.

Similar to other parts of the country, HIV criminalization laws have not only resulted in prison sentences, but have also had a chilling effect on people’s day-to-day safety. Testifying before the House Special Rules Committee, Nina Martinez, a member of the Coalition to End HIV Criminalization in Georgia, recounted being sexually assaulted by a fellow student at Emory University nine years earlier. “Because of this law I immediately knew that I wasn’t going to report it to law enforcement,” she told them. “It was never going to be about consent, it was going to be about my HIV status. And so I was afraid of the very real possibility of going to prison for my own sexual assault because of this law.”

In February, Georgia Representative Sharon Cooper introduced House Resolution 240, which proposed creating a Joint Study Committee on Reforming HIV Related Criminal Laws. The following month, Senator Vincent Fort introduced the Senate counterpart, Resolution 465. “Most of these laws do not account for actual scientifically supported levels of risk by types of activities engaged in or risk reduction measures taken,” stated the resolution. “As a result, many of these state laws criminalize behaviors that the [Centers for Disease Control and Prevention] regards as posing either no or negligible risk for HIV transmission even in the absence of risk reduction measures[.]” The committee includes not only state senators, but also a representative from the Department of Health, a criminal defense attorney and a community-based HIV service provider.

Ohio Rethinks HIV Criminalization

In 2016, the Ohio Supreme Court announced that it would hear State of Ohio v. Orlando Batista, in which Batista was convicted of non-disclosure and sentenced to eight years in prison. At issue are the state’s HIV laws, which classify non-disclosure as a felonious assault. Like current California laws, if a person tested positive for HIV after being arrested for solicitation, that would increase the charge from a misdemeanor to a felony if they were arrested again.

As in other states, lawmakers, pressed by advocates and medical professionals, are beginning to rethink HIV criminalization. On March 2, the state’s Recodification Committee examined proposed amendments to its HIV criminal law. The Committee will vote on the amendments at a later date.

Utah Enacts Heavier Penalties for People With HIV

While some states are considering decriminalizing HIV, Utah is moving in the opposite direction. In March, Governor Gary Richard Herbert signed HB 369, or the Sexual Offenses and Statutory Nonconsent Amendments, into law.

As of 2013, 2,565 people living in Utah had been diagnosed with HIV, a rate of 115 per every 100,000 people. The following year, 120 people were newly diagnosed, a rate of five per every 100,000 people.

Initially, the bill criminalized HIV non-disclosure with the first draft making it a felony. In later drafts, non-disclosure became a misdemeanor.

Testifying against the bill in February, Troy Williams, the executive director of Equality Utah, expressed concern that the measure would discourage people from being tested and encouraged the state to instead promote testing and treatment. “We would want to do everything in our power to open the doors to encourage people to be tested,” he said. His concerns have been echoed by other advocates, including people living with HIV.

Those concerns seem to have been heard; the final law does not include criminalization for non-disclosure. It does, however, enhance penalties for people convicted of non-consensual sex offenses if they have HIV, hepatitis B or hepatitis C. The wording of the law does not acknowledge that people who are virally suppressed are not at risk of transmitting HIV through sex.

Victoria Law is a freelance writer and editor. Her work focuses on the intersections of incarceration, gender and resistance. She is the author of Resistance Behind Bars: The Struggles of Incarcerated Women.

Published in the Body on April 7, 2017

NZ: The prosecution of people living with HIV for HIV non-disclosure is at odds with medical advances

Living with HIV is no death sentence

Jane Bruning was 33 when she was told she would die.

The Auckland woman was living in Tanzania when her former partner died suddenly, almost immediately after being told he was HIV positive.

Subsequent tests revealed Bruning, mother to a young son, also had HIV.

It was the 1980s, and the news wasn’t good.

“In those days it just wasn’t considered something heterosexual people got,” says Bruning. 

“It was a shock…In Tanzania there was no information about HIV. They only had one national radio station, and one newspaper newspaper and they were both in Swahili. There was very little information — HIV was perceived as a gay man’s thing that happened in San Francisco.

“It was very, very scary because there was absolutely no infrastructure or support. I was told I had three years to live and to sleep well, eat well, and don’t have sex.”

Bruning said the ensuing period was “surreal”.

Jane Bruning, national coordinator for Positive Women, says New Zealand is at a crossroads when it comes to how we approach HIV.

She relocated to New Zealand so her family could take care of her son when she was gone.

For years she waited to die.

Then, antiretroviral​ treatment drastically changed the lives of people living with HIV for the better.

With daily medication Bruning realised she would live to meet her grandchildren after all.

Nonetheless, everything was different.

“I don’t know that it’s been a normal life and I’m not sure I would say it’s been 100 per cent healthy because of the side effects from the medication. I knew I wasn’t going to die, but I wasn’t quite sure how to live.”

Bruning, now 59, is one of a small percentage of heterosexual women in New Zealand living with HIV.

It hasn’t been an easy road.

From a medical perspective she is healthy albeit some side effects from her daily medication including peripheral neuropathy, lipoatrophy and lipodystrophy, however, life hasn’t been the same since.

She hasn’t had a partner in 20 years, which is a personal choice. “I thought I was coming home to die so I didn’t see any point in getting into a relationship”.

As the national coordinator of Positive Women, a support agency for women living with HIV and their families, she has come across cases of people being treated like lepers despite medication reducing their risk of transmission.

Earlier this month prosecutors at the Auckland District Court accused Mikio Filitonga of burying his head in the sand when it came to his own HIV diagnosis.

He was found guilty of causing grievous bodily harm to his former partner by infecting him with HIV, and of committing a criminal nuisance by having unprotected sex with him knowing he had HIV and not disclosing it.

Evidence heard at trial established Filitonga was evasive with medical authorities, shunned treatment, and didn’t tell his partner of his diagnosis.

He is one of around a dozen people who have been charged with offences relating to the infliction of HIV since Kenyan musician Peter Mwai became the first person to be prosecuted in 1994.

Unlike some countries or US states where law has been specially crafted for the offence, prosecutors in New Zealand utilise existing legislation to prosecute those whose recklessness leads to injury.

But given people living with HIV can have long, healthy lives—can injury be proven?

Filitonga’s defence lawyer Ross Burns applied to have the charges formally dismissed by the Judge, arguing that the definition of grievous bodily harm hadn’t been met because the complainant was taking medication that made him asymptomatic—technically injury free.

Judge Mary-Beth Sharp rejected the application, saying HIV was an “indisputably serious” illness.

“It is incurable, chronic, and can cause death. With respect, that says it all,” she says.

After the trial the New Zealand Aids Foundation criticised the prosecution, saying court action should only be taken where malicious intent to infect others is established.

The Sunday Star-Times asked: Should people still be prosecuted for inflicting a manageable illness when many others, such as measles, can cause the same damage but aren’t pursued through the courts.

“I do think HIV is a big deal. I wouldn’t want anyone to contract it. I wouldn’t wish it on anybody,” says Bruning.

“In saying that, with the medication making viral loads undetectable, I think we’re coming to a real crossroads. Do you need to wear condoms? Do you need to disclose your status? Clinically, there is no reason why someone should have to wear a condom or disclose. Morally, you have a whole different story.”

Long time infectious diseases physician Dr Graham Mills says it’s an “interesting paradox”, and its silly to compare HIV to measles or other highly infectious diseases that don’t become the subject of criminal prosecutions.

Society’s continued efforts to reduce transmission rates, including the prosecution of reckless persons who pass it on to others, are at odds with the fact medical advances can render HIV virtually undetectable, he says.

Mills works with a 190 HIV patients under the Waikato District Health Board umbrella and gave expert evidence in the Filitonga trial.

He wouldn’t comment on the case but admitted that he became fascinated with specialising in infectious diseases during his time as a medical student at Otago University when a mysterious illness known only as GRID (gay related immuno deficiency which later became known as HIV) became known in the United States.

Since then he has seen patients die, but many also live normal lives.

“Ask yourself, why do I want to reduce HIV? One, because it forces people to be on medication and treatment for the rest of their life.

“Two, it’s expensive. It costs about $10,000 a year for pharmaceutical and out patient costs. Most people don’t pay that much in tax per year.

“Three, it’s an ongoing epidemic, and there are people that lose in any epidemic. The people that lose out are the people that have barriers to health care.

“We’re not criminalising HIV. We never have. We have existing laws to hold people to account because someone has complained, because they believe they have come to serious harm, and therefore we’re giving them the framework with which to lay a complaint.”

Auckland University law professor Julia Tolmie says case law evolved at a time when HIV was “an inevitable death sentence”.

“That has certainly shifted now. Nonetheless the illness would still fall within the definition of grievous bodily harm, which just means ‘really seriously hurt’ or ‘really serious bodily injury’. Something can be ‘bodily injury’ even if treatment is available to cure or manage it,” she says.

The “real issue” for the courts is whether a person’s HIV positive status has been disclosed to consenting partners.

“I think there is an argument that you could apply the same legal principles to, for example, herpes, which is arguably grievous bodily harm, but may not be considered to be dangerous to life.

“I do not know about the infection process for measles but I imagine one of the difficult issues there would be establishing that a person purposefully risked infecting others—people may well be contagious before they know that they have the illness.

“Of course, there is also the need to have a complainant before criminal charges will be laid. People may well not think of informing the police where someone has deliberately risked infecting them with measles or other illnesses.”

Susan – not her real name – disagrees. Her former partner Darryl Kilpatrick was jailed briefly after he had unprotected sex with her without disclosing his HIV status.

She underwent years of testing before receiving confirmation she hadn’t been infected, but she developed post traumatic stress disorder (PTSD), and attempted suicide.

Susan firmly believes people who inflict HIV on others should be charged with a sexual offence, describing her own experience as akin to being raped.

“The effects are identical to rape and sexual violation. The breach of trust, the health issues—it’s an absolute threat to life and future sexual relationships”.

“It’s been a long, lonely journey and I have to say it’s never ending. It’s been very hard,”  says Susan.

She said people “minimised and rationalised” her situation because she hadn’t been infected, and she became frustrated with the lack of support.

“I rang the Wellington sex abuse helpline and the woman on the phone said to me, ‘I don’t know how to help you’. I just screamed at her saying, ‘can’t you see I’ve been sexually violated?'”

Susan later successfully pursued ACC through the High Court in order to get payments for her PTSD, after the agency initially said it didn’t recognise her injury.

The NZAF said prosecutions had the “significant potential” to undermine previous successes in breaking down stigma and discrimination, and reducing HIV incidence rates.

Director Jason Myers said it weakened public health messages of shared responsibility for sexual health and promoted the perception that they are “potential criminals or a threat to innocent’ people”.

“For these reasons, the application of criminal law to the transmission of HIV should be kept for those very few cases in which a person who knows their HIV status has not disclosed this to a sexual partner and acted with the express intent to transmit the virus. Invoking criminal laws in cases of adult private consensual sexual activity is disproportionate and counterproductive to enhancing public health,” said Myers.

According to Bruning there is a strong difference between keeping personal information secret knowing it won’t affect anyone else, and being reckless or deliberate.

“To me, burying your head in the sand is not is not useful, although I understand how stigma can affect people to an extent they are in denial, but that’s very different to someone who injects their blood (in 2009 an HIV positive man deliberately injected his sleeping partner with his blood to deliberately infect her so they could have sex) into someone else,” said Bruning.

Published in Stuff on April 2, 2017